Increased dose not helping - should I reduce?

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I started on Venlafaxine in January for anxiety and agoraphobia. 

When I was on 150mg (2 tablets twice a day) it was really helping with the anxiety, but not so much with the agoraphobia. 

It was then increased to 225mg., I have now been on 225mg for 3 months and it doesn't seem to have helped anymore than the 150mg. in fact I think it may have made the anxiety slightly worse.

I'm thinking maybe I should go back down to the 225mg and add something else for the agoraphobia.

Any advice on how slowly I should reduce it? Or what I could add to help with agoraphobia?

 

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  • Posted

    Hello, think you need a pysc evaluation for that, if not a doctor., for both aggrophobia and potentially dropping dose. Did the aggrobia develope after anxiety? Reason i ask is that i started ven for depression 2 months ago. Only as a result of depression, did i get anxious about going out. I would go out at my worst, if i had to, but avoided it if i had a choice, as it made my anxiety worse. Im also on diazepam, and thats very good for anxiety and going outside. Have got a lot better on ven over last month on 225mg, and going out now isnt much of an issue now. The diazepam really helped me get used to going out again. It avoided feeling anxious outside, and worrying whether i looked weird to other people, because of anxiety. Dont know whether this helps. Dropping a dose, needs professional guidance.
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    • Posted

      Sorry for the late reply. Thanks nigel45109, I have had anxiety since I was little but it has gradually got worse as I got older. I have got diazepam, but rarely take it as I'm so concerned that I will come to rely on it. I have got a doctors appointment in a couple of weeks, so will speak to him then.

       

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  • Posted

    I found I was better on slow release I am on 300 mg 2x150 mg daily. .when I was on immediate release I felt agoraphobic due to anxiety .also it does take a while for each increase for the body/brain to adjust which I felt each time I had an increase in tabs .like Nigel says your doctor or phyc will help with adjustment do not attempt on your own.hope this helps Talla give yourself time you will get better .

     

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    • Posted

      Sorry for the late reply. Thanks dawn41372 - the doctor that I saw said that I couldn't have more than 225mg, but I am seeing another doctor soon so will see what he has to say. Interesting to hear that the slow release tablets were better - will ask about those.

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  • Posted

    My understanding of Venlafaxine is that with dosages up to 150mg/day the response in the body is purely (perhaps just mostly) Serotonergic - only dealing with serotonin.  Increased Serotonin helps relieve stress and anxiety, hence why lower dosages are intended for anxiety issues.  

    Above 150mg, it works to affect norepinephrine and dopamine in the brain, which in the case of norepinephrine, can increase anxiety.  you may have been better off with a lower dosage for that reason.  I am not sure about the agoraphobia, but one thought may be that you find better results doing behavioral remedies to the agoraphobia once your general anxiety is more in check through your venlafaxine treatment.  

    Good luck with everything.  

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    • Posted

      Thanks al10964 - sorry for the late reply. That is interesting to hear - I need to speak to my doctor and see what he thinks is best. Unfortunately, I have tried just about everything for the agoraphobia, but nothing seems to have really helped apart from medication.
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  • Posted

    I agree with al10964, behavioural remedies are needed for agoraphobia. Exposure therapy is the best way. I have been so bad that I went from not being able to leave my house to not even being able to leave my bedroom! You have to push yourself to do things, small things at first. Even just going outside your house and standing there for a few mins to start with. Have you got someone who can be there with you? To go on small walks with you? Have you been given diazepam or anything similar? That helped me a lot when I started going to supermarkets again. Sometimes just having one in my bag, knowing I could take it if I started to panic was enough! X
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    • Posted

      Thanks Rhubarb57 . My agoraphobia has been really severe in the past. I have pushed myself, so now I am able to do things locally, but still struggle with any travelling. What dose of diazepam helps you? I have 2mg tablets.
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    • Posted

      I have 2mg too. I realised today that I haven't taken any for 2 weeks! Hopefully you'll find that you're using them less and less and then suddenly realise that you've not needed any like I did today. I still get anxious if I travel but I have diazepam with me and I do positive self talk. I read the "overcoming agoraphobia" book which helped a lot. Do you have a counsellor/therapist? X

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    • Posted

      I don't have a therapist or anything at the moment. I've had CBT in the past and also private therapists, acupuncture, hypnotherapy, homeopathy, chinese medicine - you name it and i have probably tried it! I'll have to have a look at that book - I'm not sure if i have read it. Do you find that 2mg of diazepam is enough to help you? x

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